Surgery (Schwartz) 9th ch. 1-15
In a patient requiring massive transfusion, 1 unit of FFP (fresh frozen plasma) should be given for every A. 1.5 units of PRBCs (1 to 1.5 ratio FFP:PRBC) B. 3 units of PRBCs (1 to 3 ratio FFP:PRBC) C. 6 units of PRBCs (1 to 6 ratio FFP:PRBC) D. 8 units of PRBCs (1 to 8 ratio FFP:PRBC)
A. 1.5 units of PRBCs (1 to 1.5 ratio FFP:PRBC)
In a 70-kg patient, transfusion of I unit of platelets should raise the circulating platelet count by approximately A. 10,000 B. 20,000 C. 30,000 D. 40,000
A. 10,000
A patient arrives in the ER following a motor vehicle accident with multiple injuries. Hypotension in this patient is defined as systolic blood pressure less than A. 110 B. 90 C. 70 D. 50
A. 110
Which of the following is defined as a massive hemothorax? A. 1600 ml of intrathoracic blood in a 100-kg woman B. 900 m of intrathoracic blood in a 70-kg man C. 800 ml of intrathoracic blood in a 50-kg woman D. 200 ml of intrathoracic blood in a 20-kg boy
A. 1600 ml of intrathoracic blood in a 100-kg woman
How long does re-epithelialization (i.e., complete repair of the external barrier) take in a well-approximated surgical wound? A. 2 days B. 1 week C. 2 weeks D. 1 month
A. 2 days
Approximately how many genes are present in the human genome? A. 25,000 B. 100,000 C. 250,000 D. 750,000
A. 25,000
Appropriate duration of antibiotic therapy for most patients with bacterial peritonitis from perforated appendicitis is A. 3-5 days B. 7-10 days C. 14-21 days D. >21 days
A. 3-5 days
The appropriate duration of antibiotic therapy for nosocomial urinary tract infection is A. 3-5 days B. 7-10 days C. 21 days D. Until the patient is asymptomatic and the urinalysis is normal
A. 3-5 days
Ischemia time of a harvested lung should ideally be less than A. 6 hours B. 12 hours C. 24 hours D. 36 hours
A. 6 hours
Insulin drips should be used to maintain serum glucose in nondiabetic, critically ill patients at levels between A. 80 and 110 mg/dL B. 100 and 150 mg/dL C. 120 and 200 mg/ dL D. 150 and 250 mg/dL
A. 80 and 110 mg/dL
Insulin drips should be used to maintain serum glucose in nondiabetic, critically ill patients at levels between A. 80 and 110 mg/dL B. lO0and 150mg/dL C. 120 and 200 mg/ dL D. 150 and 250 mg/ dL
A. 80 and 110 mg/dL
A 24-year-old arrives at the emergency department (ED) with multiple stab wounds to the abdomen, severe blunt trauma to the head (GCS 10), and a systolic blood pressure of 80 mm Hg. An appropriate goal for resuscitation in the ED would be a systolic blood pressure of A. 80- 90 mm Hg B. 90-100 mm Hg C. 100- 110 mm Hg D. 110- 120mmHg
A. 80- 90 mm Hg
Which of the following is the most significant risk factor for invasive breast cancer when screening a patient for risk? A. >2 first-degree relatives with breast cancer B. 2 previous breast biopsies in a patient <50 years of age C. Age < 12 at menarche D. Atypical hyperplasia in a previous breast biopsy
A. >2 first-degree relatives with breast cancer
Which of the following is an indication for a lower leg fasciotomy? A. >35-mmHg difference in diastolic pressure and the compartment pressure B. >35-mmHg difference in mean arterial pressure and the compartment pressure C. >25mmHg difference in systolic pressure and the compartment pressure D. >25-mmHg compartment pressure, regardless of blood pressure
A. >35-mmHg difference in diastolic pressure and the compartment pressure
Which of the following patients should be immediately referred to a burn center? A. A 20-year-old with a 12% partial thickness burn B. A 30-year-old with a major liver injury and a 15% partial thickness burn C. A 2% TBSA partial thickness burn to the anterior leg, crossing the knee D. A 10-year-old with a 7% partial thickness burn
A. A 20-year-old with a 12% partial thickness burn
An intron is A. A segment of DNA removed prior to transcription B. The remaining (functional) segment of DNA after removal of non-functional DNA C. A segment of mRNA removed prior to translation D. The remaining (functional) segment of mRNA after removal of non-functional RNA
A. A segment of DNA removed prior to transcription
Which of the following is the most effective dosing of antibiotics in a patient undergoing elective colon resection? A. A single dose given within 30 min prior to skin incision B. A single dose given at the time of skin incision C. A single preoperative dose + 24 hours of postoperative antibiotics D. A single preoperative dose + 48 hours of postoperative antibiotics
A. A single dose given within 30 min prior to skin incision
Which of the following is most suggestive of a necrotizing soft tissue infection and would mandate immediate surgical exploration? A. A small amount of greyish, cloudy fluid from a wound B. Red, swollen extremity which is tender to palpation C. Soft tissue infection with a fever> 104° D. Induration with pitting edema on the trunk
A. A small amount of greyish, cloudy fluid from a wound
A 100-kg patient with a 50% TBSA full thickness burn receives 10 L of 0.9% NaCl solution in transit to the hospital. His laboratory values 6 hours after the injury are likely to reflect which of the following: A. Acidosis B. Alkalosis C. Hypoxia D. Dilutional anemia
A. Acidosis
Vasoconstriction is one of the initial physiologic responses to hypovolemic shock. This is mediated by A. Activation of alpha adrenergic receptors on the arterioles B. Downregulation of alpha adrenergic receptors on the arterioles C. Activation of beta adrenergic receptors on the arterioles D. Downregulation of beta adrenergic receptors on the arterioles
A. Activation of alpha adrenergic receptors on the arterioles
Which of the following would mandate elective intubation in a patient with a normal voice, normal oxygen saturation, and no respiratory distress? A. Airway bleeding B. Stab wound to the neck with mild swelling in the left lateral neck C. Localized right lateral subcutaneous emphysema D. Bilateral mandibular fracture
A. Airway bleeding
Class I HLA antigens are expressed on the membrane of A. All nucleated cells B. B lymphocytes C. Monocytes D. Dendritic cells
A. All nucleated cells
What is the most common indication for intubation in a trauma patient? A. Altered mental status B. Inhalation injury C. Facial injury D. Cervical hematoma
A. Altered mental status
The most common mode of inheritance of Ehlers-Danlos Answer: A Syndrome is A. Autosomal dominant B. Autosomal recessive C. X-linked dominant D. X-linked recessive
A. Autosomal dominant
Which of the following is a function of heat shock proteins? A. Binding of autologous proteins to improve ligand binding B. Induction of the white cell oxidative burst C. Binding to capillary endothelium to prevent fluid extravasation D. Stabilization of membranes to prevent cell lysis
A. Binding of autologous proteins to improve ligand binding
The agent most effective in treating hydrofluoric acid burns is A. Calcium B. Magnesium C. Vitamin K D. Vitamin A
A. Calcium
Apoptosis is accomplished by activation of A. Capsases B. Metalloproteases C. Complement D. Heat shock protein
A. Capsases
A patient with Lynch syndrome 2 is at increased risk for A. Carcinoma of the endometrium B. Secretory carcinoma of the breast C. Osteosarcoma D. Melanoma
A. Carcinoma of the endometrium
An unconscious patient with a systolic BP of80 and a HR of 80 most likely has A. Cardiogenic shock B. Hemorrhagic shock C. Neurogenic shock D. Obstructive shock
A. Cardiogenic shock
Hypoxia at the cellular level decreases ATP production (also called dysoxia). This results in A. Changes in intracellular calcium signalling B. Increased cell membrane potential C. Increased intracellular pH D. Increased number of mitochondria
A. Changes in intracellular calcium signalling
Which of the following proteins is defective in patients with osteogenesis imperfecta (Ol)? A. Collagen type I B. Fibrillin C. Lysyl hydroxylase D. Fibronectin
A. Collagen type I
Laser therapy restores luminal patency in a blood vessel by A. Coring out the obstructive lesion B. Fracturing the obstructive lesion C. Chemically dissolving the obstructive lesion D. None of the above
A. Coring out the obstructive lesion
Which of the following is one of the variables of the MELD score? A. Creatinine B. Age C. Degree of encephalopathy D. Cause of hepatic failure
A. Creatinine
Which of the following is an alkylating agent? A. Cyclophosphamide B. Doxorubicin C. Pactitaxel D. Vincristine
A. Cyclophosphamide
The number of medical errors which kill patients in the United States is the equivalent of one jumbo jet crashing every A. Day B. Week C. Month D. 3 months
A. Day
How long does protein calorie malnutrition need to be present in patients in order to affect wound healing? A. Days B. Weeks C. 1 month D. >3 months
A. Days
Which of the following is one of the three principles of the ACS Code of Professional Conduct? A. Dedication to the patient's welfare, independent of administrative forces B. Reasonable reimbursement for testifying as an expert witness C. Accepting patients, regardless of ability to pay D. Referring patients to other doctors when conflicts do not allow the surgeon to continue to care for the patient
A. Dedication to the patient's welfare, independent of administrative forces
Which of the following is seen in patients with Ehlers Danlos syndrome (EDS)? A. Elevated PT/PTT B. Spontaneous arteriovenous fistulae C. Severe internal hemorrhoids D. Portal hypertension
A. Elevated PT/PTT
The vagus nerve mediates which of the following in the setting of systemic inflammation? A. Enhanced gut motility B. Decreased protein production by the liver C. Decreased tumor necrosis factor (TNF) production D. Increased heart rate to increase cardiac output
A. Enhanced gut motility
In a patient with ongoing hemorrhage, the risk of death increases 1 % A. Every 3 minutes in the ER B. Every 10 minutes in the ER C. Every 30 minutes in the ER D. Every 60 minutes in the ER
A. Every 3 minutes in the ER
Which of the following is NOT a gene associated with hereditary cancer A. FBNI B. CDHI C. HER2 D. RET
A. FBNI
The primary source of calories during acute starvation (<5 days fasting) is A. Fat B. Muscle (protein) C. Glycogen D. Ketone bodies
A. Fat
Which of the following is the primary fuel source after acute injury? A. Fat B. Muscle (protein) C. Glycogen D. Ketone bodies
A. Fat
Intra-abdominal adhesions can be decreased after laparotomy by A. Frequent irrigation to keep bowel surfaces moist B. Using antibiotic irrigation at the completion of the case C. Wrapping anastomoses in hyaluronic acid sheets prior to closure D. Using only monofilament sutures in abdominal wound closure
A. Frequent irrigation to keep bowel surfaces moist
A patient presents obtunded to the ER with the following labs: Na 130 Cl 105 K 3.2 HC03 15. Which of the following is the most likely diagnosis? A. GI losses B. Lactic acidosis C. Methanol ingestion D. Renal failure
A. GI losses
Which of the following is a potential physiologic effect of anabolism (positive nitrogen balance)? A. Glycosuria B. Metabolic acidosis C. Hypercalcemia D. Hypermagnesemia
A. Glycosuria
Formic acid burns are associated ·with A. Hemoglobinuria B. Rhabdomyolosis C. Hypocalemia D. Hypokalemia
A. Hemoglobinuria
Which of the following would cause decreased deep tendon reflexes? A. Hypokalemia B. Hypomagnesemia C. Hypocalcemia D. Hypoglycemia
A. Hypokalemia
A postoperative patient with a potassium of 2.9 is given 1 mEq/kg replacement with KCl (potassium chloride). Repeat tests after the replacement show the serum K to be 3.0. The most likely diagnosis is A. Hypomagnesemia B. Hypocalcemia C. Metabolic acidosis D. Metabolic alkalosis
A. Hypomagnesemia
Which of the following is an indication for liver transplantation in a patient with acute liver failure? A. INR >6.5 B. Age <40 C. Creatinine >2.0 D. Duration of jaundice >3 days prior to onset of encephalopathy
A. INR >6.5
Which of the following is the best meth od to decrease the risk of renal failure in a patient with myoglobinuria? A. IV hydration to maintain good urine output B. Sodium bicarb to maintain urine pH >8 C. Mannitol D. Lasix
A. IV hydration to maintain good urine output
Which of the following best describes the hemodynamic response to neurogenic shock? A. Increased cardiac index, unchanged venous capacitance B. Increased cardiac index, decreased venous capacitance C. Variable change in cardiac index (can increase or decrease), increased venous capacitance D. Variable change in cardiac index (can increase or decrease), decreased venous capacitance
A. Increased cardiac index, unchanged venous capacitance
Prostacyclin has which of the following effects in systemic inflammation? A. Inhibition of platelet aggregation B. Vasoconstriction C. Increased adhesion molecules D. Decreased cardiac output
A. Inhibition of platelet aggregation
Which phase of healing is most affected by exogenous corticosteroids? A. Initial phase of cell migration and angiogenesis B. Proliferative phase C. Maturation D. Scar remodeling
A. Initial phase of cell migration and angiogenesis
Which of the following could cause a simultaneous increase in peak airway pressure AND plateau airway pressure? A. Intrinsic PEEP B. Endotracheal tube plugging C. Bronchospasm D. Insufficient expiratory time
A. Intrinsic PEEP
In addition to stopping the heparin, a patient with heparin-induced thrombocytopenia (HIT) should be treated with A. Lepirudin B. Low molecular weight heparin C. Warfarin D. Aspirin
A. Lepirudin
Which of the following is the initial enteral formula for the majority of surgical patients? A. Low-residue isotonic formula B. Elemental formula C. Calorie dense formula D. High protein formula
A. Low-residue isotonic formula
Which of the following is a critical component of the initial response to bacterial contamination of the peritoneal cavity? A. Macrophage upregulation B. Platelet adherence C. Phagocytosis by PMNs D. Opsonization
A. Macrophage upregulation
Epstein Barr virus (EBV) is associated with which of the following cancers? A. Nasopharyngeal carcinoma B. Non-Hodgkin's lymphoma C. Adult T-cell leukemia D. Kaposi's sarcoma
A. Nasopharyngeal carcinoma
Which one of the following high-risk organizations has achieved an exceptionally low accident and error rate? A. Navy nuclear submarine program B. U.S. Postal Service C. Auto manufacturing industry D. Food services industry
A. Navy nuclear submarine program
The appropriate treatment of an asymptomatic patient with a stab wound to Zone III of the neck is A. Observation B. CT of the neck C. Angiography D. Operative exploration
A. Observation
Which of the following is the most appropriate initial treatment of a sucking chest wound? A. Occlusive dressing taped on 3 out of 4 sides B. Chest tube placed through the wound, cover wound chest tube) with occlusive dressing C. Chest tube placed in a clear area, closure of the wound D. Closure of the wound, intubation of the patient, sedation
A. Occlusive dressing taped on 3 out of 4 sides
Cyclosporine levels may be decreased in patients who are also taking A. Phenytoin B. Erythromycin C. Cimetidine D. Fluconazole
A. Phenytoin
Which of the following increases the risk of a complication while placing a central line? A. Placing a central line at the request of another surgeon B. Placement by a lower level (PGY3) resident C. Failure to place the patient in Trendelenburg position D. Changing a line when infected, rather than on a protocol set schedule
A. Placing a central line at the request of another surgeon
Cytokines are which type of hormone? A. Polypeptide B. Amino acid C. Fatty acid D. Carbohydrate
A. Polypeptide
Most chemical burns require large volumes of water to remove the chemical. Which of the following chemical burns should be treated by careful wiping or sweeping of the skin, rather than water? A. Powdered form of lye B. Formic acid C. Hydrofluoric acid D. Acetic acid
A. Powdered form of lye
A patient on chronic warfarin therapy presents with acute appendicitis. INR is 1.4. Which of the following is the most appropriate management? A. Proceed immediately with surgery without stopping the warfarin B. Stop the warfarin, give fresh frozen plasma, and proceed with surgery C. Stop the warfarin and proceed with surgery in 8-12 hours D. Stop the warfarin and proceed with surgery in 24-36 hours
A. Proceed immediately with surgery without stopping the warfarin
A 28-year-old patient with chronic granulomatous disease is scheduled for cystoscopy under general anesthesia. Which of the following tests should be obtained preoperatively? A. Pulmonary function test B. Echocardiogram C. Abdominal ultrasound D. EKG
A. Pulmonary function test
The leading cause of graft loss following renal transplantation is A. Recipient death B. Acute rejection C. Chronic nephropathy D. Pyelonephritis
A. Recipient death
Which of the following is a normal physiologic change during pregnancy? A. Relative anemia B. Decrease in circulating blood volume C. Respiratory acidosis D. Bradycardia
A. Relative anemia
Identification of a specific DNA segment can be accomplished by A. Southern blotting B. Northern blotting C. Western blotting D. Eastern blotting
A. Southern blotting
Which of the following diagnoses would be most likely in a patient who presents with normovolemic hyponatremia? A. Syndrome of inappropriate anti-diuretic hormone secretion (SIADH) B. High output renal failure C. Water toxicity D. GI losses
A. Syndrome of inappropriate anti-diuretic hormone secretion (SIADH)
Which Of the following is an important cytokine mediator of wound healing? A. TGFß B. alpha-interferon C. Interleukin 12 D. ß-Defensin 2
A. TGFß
Cowden syndrome is associated with an increased incidence of A. Thyroid cancer B. Adrenal cancer C. Colorectal cancer D. Gastric cancer
A. Thyroid cancer
Which of the following stimulates the extrinsic (death receptor) apoptotic pathway? A. Tumor necrosis factor B. DNA damage C. Release of cytochrome C from the mitochondria D. BcL-2 activation
A. Tumor necrosis factor
There are 18 types of collagen in the human body. Which two are the most important in wound healing? A. Type I and III B. Type III and VIII C. Type II and X D. Type VI and XII
A. Type I and III
Which of the following can be used to mitigate cortisol effects on wound healing? A. Vitamin A B. Vitamin B1 C. Vitamin C D. Vitamin E
A. Vitamin A
Which of the following should be given to promote wound healing in patients receiving steroids? A. Vitamin A B. Vitamin B1 C. Vitamin B2 D. Vitamin C
A. Vitamin A
Certain breast cancer subtypes preferably spread to certain organs. This is an example of A. Tumor dormancy B. "Seed and soil" theory C. Lymphatic spread D. In situ carcinoma
B. "Seed and soil" theory
A 27-year-old man presents to the ED after receiving blows to the head. He opens his eyes with painful stimuli, is confused, and localizes to pain. What is his Glasgow Coma Score? A. 13 B. 11 C. 9 D. 7
B. 11
What percent of the population is Rh negative? A. 5% B. 15% C. 25% D. 35%
B. 15%
A 25-year-old man presents following blunt trauma to the abdomen. FAST exam shows injury to the spleen. His HR is 110, RR is 25 and he is mildly anxious. What percentage of his blood volume do you estimate he has lost? A. <15% B. 15-30% C. 30-40% D. >40%
B. 15-30%
What percentage of the blood volume is normally in the splanchnic circulation? A. 10% B. 20% C. 30% D. 40%
B. 20%
How many calories per day are required to maintain basal metabolism in a healthy adult? A. 10-15 kcal/kg/ day B. 20-25 kcal/kg/day C. 30-35 kcal/kg/day D. 40-45 kcal/kg/day
B. 20-25 kcal/kg/day
The width of a blood pressure cuff should be what percentage of the circumference of the patient's arm? A. 30% B. 40% C. 50% D. 60%
B. 40%
What percentage of breast cancers are hereditary? A. <1% B. 5-10% C. 30% D. 50%
B. 5-10%
Sepsis increases metabolic needs by approximately what percentage? A. 25% B. 50% C. 75% D. 105%
B. 50%
Approximately how many people die of cancer annually in the United States? A. 100,000 B. 500,000 C. 2,000,000 D. 5,000,000
B. 500,000
The peak number of fibroblasts in a healing wound occurs A. 2 days after injury B. 6 days after injury C. 15 days after injury D. 60 days after injury
B. 6 days after injury
The approximate IV rate for maintenance fluids for a 50-kg patient would be A. 75 ml/hr B. 90 ml/hr C. 105 ml/hr D. 120 ml/hr
B. 90 ml/hr
ICP monitoring is indicated for a patient with A. An abnormal CT of the brain and a Glasgow Coma Scale score of 10 after traumatic brain injury B. A normal CT of the brain after traumatic brain injury, systolic BP <91, and age >40 C. A normal CT of the brain and hepatic failure with coma D. A normal CT of the brain and coma after anoxia
B. A normal CT of the brain after traumatic brain injury, systolic BP <91, and age >40
Rejection that starts on postoperative day 2 is most likely A. Hyperacute rejection B. Accelerated acute rejection C. Acute rejection D. Chronic rejection
B. Accelerated acute rejection
What are the "AB Cs" of the primary survey? A. Assess (stability of patient), Begin (treatment), Cervical spine (don't forget to stabilize the cervical spine) B. Airway, Breathing, Circulation C. Accident (history), Background (patient's past medical history), Community (family medical history) D. Assess, Begin (to treat), Complete (evaluation of all injuries)
B. Airway, Breathing, Circulation
Which of the following may help prevent ototoxicity in a patient receiving vancomycin? A. N-acetylcysteine B. Alpha-tocopherol C. Ferrous sulfate D. Thalidomide
B. Alpha-tocopherol
An alginate dressing is best used in which of the following wounds? A. An open traumatic wound B. An open surgical wound C. An infected wound D. A partial thickness burn wound
B. An open surgical wound
Supplementation with which of the following amino acids may improve wound healing? A. Glutamine B. Arginine C. Alanine D. Guanine
B. Arginine
Which of the following is thought to have contributed to a decrease in the worldwide mortality rate of gastric cancer? A. Lower intake of fruits B. Better food preservation C. Routine laboratory monitoring D. More effective therapy after diagnosis
B. Better food preservation
Titration of sedation in the ICU can be improved by monitoring with A. Continuous EEG B. Bispectral index (BIS) C. Serum levels of the drug(s) being used D. Near infrared spectrometry
B. Bispectral index (BIS)
Which of the following is considered confirmatory of the diagnosis of abdominal compartment syndrome? A. Bladder pressure >15 mmHg B. Bladder pressure >25 mmHg C. Bladder pressure >35 mmHg D. Bladder pressure >45 mmHg
B. Bladder pressure >25 mmHg
A 45-year-old, otherwise healthy woman presents after a moving vehicle accident. She is hemodynamically stable and with only minimal tenderness in her right upper quadrant. A FAST exam (focused abdominal sonographic test) is positive with fluid seen in the hepatorenal fossa and the pelvis. Which of the following is the next best step in her management? A. Observation only B. CT scan C. Laparoscopy D. Exploratory laparotomy
B. CT scan
A 70-kg -man with a laceration to the brachial artery loses a total of 800 mL of blood. What ACS (American College of Surgeons) class of hemorrhage would this represent? A. Class I hemorrhage B. Class II hemorrhage C. Class III hemorrhage D. Class IV hemorrhage
B. Class II hemorrhage
Omega-3 fatty acids have which of the following effects on the inflammatory response? A. Increased inflammatory response B. Decreased inflammatory response C. Delayed inflammatory response D. No effect on the inflammatory response
B. Decreased inflammatory response
Factor XIII deficiency most commonly presents as A. Severe intraoperative bleeding B. Delayed bleeding after injury or surgery C. Spontaneous hemarthrosis D. Spontaneous gastrointestinal bleeding
B. Delayed bleeding after injury or surgery
Which of the following proteins is defective in patients Marfan's syndrome? A. Collagen type I B. Fibrillin C. Lysyl hydroxylase D. Fibronectin
B. Fibrillin
Which topical anticoagulating agent is best for use in patients with a coagulopathy? A. Gelfoam B. Fibrin sealant C. Thrombostat (topical thrombin) D Surgiceal
B. Fibrin sealant
Which of the following components of wound healing is impaired in a child with acrodermatis enteropathica (AE)? A. Macrophage signaling B. Formation of granulation tissue C. Collagen deposition D. Collagen cross-linking
B. Formation of granulation tissue
Malignant cells are LEAST likely to be in which of the following stages of the cell cycle? A. S phase B. G0 phase C. G1 phase D. M phase
B. G0 phase
Surgeons should receive an immunization to protect them from infection with A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Human Immunodeficiency Virus
B. Hepatitis B
The most common virus transmitted by transfusion is A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Human Immunodeficiency Virus (HIV)
B. Hepatitis B
DNA microarrays allow identification of gene mutations using A. Polymerase chain reaction B. Hybridizahon C. Western blotting D. Molecular cloning
B. Hybridizahon
Which of the following can initiate afferent impulses to the CNS which triggers the neuroendocrine response of shock? A. Severe alkalosis B. Hypothermia C. Hyperthermia D. Hyperglycemia
B. Hypothermia
A 72-year-old woman suffered an acute MI and, 12 hours later, is in cardiogenic shock. Which of the following is the best treatment for this patient? A. Inotropic support until stabilized then PTCA (percutaneous transluminal coronary angiography) B. Immediate PTCA with stenting, if feasible C. Immediate PTCA to define anatomy followed by coronary artery bypass D. None of the above
B. Immediate PTCA with stenting, if feasible
Which of the following occurs in abnormally proliferating, transformed cells? A. Anchorage-dependent growth B. Immortalization C. Increased contact inhibition D. Increased cell-cell adherence
B. Immortalization
Leaks from a bowel anastomosis most commonly occur 5 to 7 days after surgery. The reason is A. Delayed collagen deposition B. Increased collagenolysis C. Breakdown of the initial fibrin seal by intraluminal bacteria D. Increased macrophage migration from the peritoneum
B. Increased collagenolysis
Hypercarbia from a CO2 pneumoperitoneum can cause A. Bradycardia B. Increased myocardial oxygen demand C. Metabolic acidosis D. Hypocalcemia
B. Increased myocardial oxygen demand
Overfeeding (RQ > 1.0) in a critically ill patient can result in A. Pancreatitis B. Increased risk of infection C. Atelectasis D. Increased risk of DVT
B. Increased risk of infection
During placement of a Swan Ganz catheter, the patient coughs up a significant amount of blood. The initial step to manage this complication is A. Nothing B. Inflate the balloon on the Swan Ganz catheter C. Intubate the patient D. Emergent thoracotomy
B. Inflate the balloon on the Swan Ganz catheter
Which of the following should be the first treatment administered to a patient with a potassium level of 6.3 and flattened P waves on their ECG? A. Kayexalate B. Insulin and glucose C. Calcium gluconate D. Inhaled albuterol
B. Insulin and glucose
A teenage, African American girl presents with large keloids on both earlobes 12 months following ear piercing. Which therapy should be added to surgical debulking of the lesions? A. None- surgical resection alone is sufficient as the initial therapy B. Intralesional corticosteroids C. Pressure earrings D. Radiation therapy
B. Intralesional corticosteroids
Which of the following has been shown to decrease wound infections in a clean contaminated wound (e.g., nonperforated appendicitis)? A. Antibiotic impregnated plastic drape placed prior to skin incision B. Irrigation of the wound with saline solution prior to closure C. Irrigation of the abdomen with antibiotic solution prior to closure D. 24 to 28 hours of antibiotics after surgery
B. Irrigation of the wound with saline solution prior to closure
Which of the following antifungal agents is associated with decreased cardiac contractility? A. Liposomal amphotericin B B. Itraconozole C. Voriconozole D. Caspofungin
B. Itraconozole
Following transplantation, patients are at increased risk for which of the following malignancies? A. Melanoma B. Kaposi's sarcoma C. Colon cancer D. Follicular carcinoma of the thyroid
B. Kaposi's sarcoma
Which of the following are adhesion molecules (i.e., cells that mediate leukocyte to endothelial adhesion)? A. Platelet activating factor B. L-selectin C. Transforming growth factor beta (TGF-ß) D. Tumor necrosis factor (TNF)
B. L-selectin
BRCA2 mutations are associate with all of the following EXCEPT A. Gastric cancer B. Lung cancer C. Ovarian cancer D. Prostate cancer
B. Lung cancer
2 hours following major surgery with significant blood loss, a patient has a base deficit of - 6. This would be classified as A. Mild base deficit B. Moderate base deficit C. Severe base deficit D. Extremely severe base deficit
B. Moderate base deficit
A healthy 20-year-old presents to the emergency room with a large, contaminated laceration that he received during a touch football game. Which of the following solutions should be used to irrigate this wound? A. Sterile water B. Normal saline C. Dilute iodine solution D. Dakin's solution
B. Normal saline
Patients with hereditary melanoma due to a p16 mutation are also at higher risk for A. Thyroid cancer B. Pancreatic cancer C. Colorectal cancer D. Breast cancer
B. Pancreatic cancer
The most common cause of a sentinel event such as wrong site surgery is A. Inadequate training of personnel involved B. Poor communication C. Inadequate patient assessment prior to the procedure D. Critical information unavailable at the time of the procedure
B. Poor communication
The diagnosis of heparin-induced thrombocytopenia is made by A. >20% fall in platelet count B. Positive serotonin release assay C. Platelets <25,000 with clinical bleeding D. Prolonged aPTT
B. Positive serotonin release assay
Which of the following is NOT one of the six cell alterations that permit malignant growth to occur in cells? A. Self-sufficiency of growth signals B. Predisposition to apoptosis C. Angiogenesis D. Invasion and metastasis
B. Predisposition to apoptosis
Translation of mRNA into proteins occurs in the A. Mitochondria B. Ribosomes C. Cytoplasm D. Cell membrane
B. Ribosomes
Which of t11e following can be used to decrease the risk of a retained sponge? A. Limiting the use of sponges by liberal use of suction B. Routine radiographs in patients undergoing multiple procedures C. Delaying wound closure until the count is completed D. Routine radiograph in patients with a BMI >40
B. Routine radiographs in patients undergoing multiple procedures
DNA replication occurs in which phase of the cell cycle? A. G1 B. S C. G2 D. M
B. S
A patient presents to the emergency room with a temperature of 39° C, a heart rate of 115, and a respiratory rate of 25. There are no localizing symptoms and the work-up does not reveal any specific source for the fever. Which of the following best describes this patient's condition? A. Infection B. SIRS C. Sepsis D. Septic shock
B. SIRS
Which of the following are mandated by the Residency Review Committee of the ACGME? A. One-on-one teaching with attending surgeons B. Surgical skills laboratory C. Departmental library with Internet access D. Morning report
B. Surgical skills laboratory
The most significant side effect of sirolimus is A. Nephrotoxicity B. Thrombocytopenia C. Glucose intolerance D. Leukopenia
B. Thrombocytopenia
A stable patient with a Grade III splenic laceration has the following laboratory results 2 hours after admission: Hg/Hct 8.7/29 Pit 70,000 INR 1.3. A. No transfusions are indicated B. Transfuse PRBCs only C. Transfuse PRBCs and platelets D. Transfuse PRBCs, platelets, and FFP
B. Transfuse PRBCs only
Tumor staging for most epithelial cancers includes all of the following EXCEPT A. Tumor size B. Tumor mutations C. Nodal involvement D. Distant spread
B. Tumor mutations
The major cause of death following renal transplantation is A. Rejection with acute renal failure B. Vascular (myocardial infarction or stroke) C. Malignancy D. Sepsis
B. Vascular (myocardial infarction or stroke)
The ideal time to administer prophylactic antibiotics to apatient undergoing a colon resection is A. 8 hours before surgery with a dose repeated at the time of incision B. 2 hours before surgery with a dose repeated at the time of incision C. 1 hour before surgery D. At the time of incision
C. 1 hour before surgery
Cortisol is elevated in response to severe injury. How long can this response persist in a patient with a significant burn? A. 2 days B. 1 week C. 1 month D. 3 months
C. 1 month
Which of the following best estimates the risk of a surgical site infection (SSI) in a patient undergoing an elective low anterior colon resect ion? A. 1-5% B. 2-10% C. 10-25% D. >25%
C. 10-25%
A patient is admitted with a glucose of 500 and a sodium of 151. Which of the following is the best approximation of the patient's actual serum sodium level? A. 158 B. 151 C. 145 D. 138
C. 145
An INR of 1.5 on arrival to the intensive care unit (ICU) is associated with what probability of death? A. INR is not predictive of outcome B. 10% C. 20% D. 30%
C. 20%
What percentage of malignant tumors have activating mutations in one of the ras genes? A. 1% B. 5% C. 20% D. 70%
C. 20%
The affinity of carbon monoxide for hemoglobin is A. 2-5 times greater than oxygen B. 20-50 times greater than oxygen C. 200-250 times greater than oxygen D. 2000-2500 times greater than oxygen
C. 200-250 times greater than oxygen
Intra-abdominal hypertension is defined by a bladder pressure greater than A. 10 cm H20 B. 15cm H20 C. 20cm H20 D. 25cm H20
C. 20cm H20
The probability of death for a patient with a base deficit of - 6 is approximately A. 5% B. 15% C. 25% D. 35%
C. 25%
Which of the following is the approximate PaCO2 for a healthy individual with an end tidal C02 (PETCO2) of 25? A. 20 B. 25 C. 30 D. None of the above—there is no accurate correlation between PaCO2 and end tidal CO2
C. 30
What is the approximate serum osmolality for a patient with the following laboratory findings? Na 130 Cl 94 K 5.2 CO2 14 Glucose 360 BUN 84 Creatinine 3.2 A. 270 B. 290 C. 310 D. 330
C. 310
The proportion of patients on the waiting list to patients transplanted is approximately A. 1:1 (waiting: transplanted) B. 1:3 (waiting: transplanted) C. 3:1 (waiting: transplanted) D. 8:1 (waiting: transplanted)
C. 3:1 (waiting: transplanted)
Critical oxygen delivery (transition from supply independent to supply-dependent oxygen delivery) occurs when oxygen delivery falls below A. 1.s mL/kg B. 2.0 mL/kg C. 4.5 mL/kg D. 6.0 mL/kg
C. 4.5 mL/kg
What percentage of body weight is made up of water? A. 10-20% B. 30-40% C. 50-60% D. 70-80%
C. 50-60%
Which of the following is the expected blood loss in a patient with 6 rib fractures? A. 240 ml B. 480 ml C. 750 ml D. 1500 ml
C. 750 ml
What is the actual serum calcium level in a patient with an albumin of 2.0 and a serum calcium level of 6.6? A. 6.6 B. 7.4 C. 8.2 D. 9.9
C. 8.2
On the third day after a carotid endarterectomy, a 68-year-old patient develops atrial fibrillation with a heart rate of 160 and a blood pressure of 96/58. The initial treatment should be A. Digoxin B. Cardioversion C. A beta blocker D. An alpha blocker
C. A beta blocker
A high level of methemoglobin will result in A. A falsely high pulse oximetry reading B. A falsely low pulse oximetry reading C. A pulse oximetry reading of 85% D. None of the above-there is no effect on the pulse oximetry reading
C. A pulse oximetry reading of 85%
Once the wound described above has been irrigated and debrided, which suture should be used to close the subcutaneous layer? A. Biologic absorbable monofilament (plain gut) B. Synthetic absorbable monofilament C. Absorbable braided D. None of the above
C. Absorbable braided
Macrophages are present in the wound starting on the 4th day after injury until the wound is completely healed. The primary function of the macrophages in wound healing is A. Intracellular killing of bacteria B. Collagen production C. Activation of cell proliferation D. Modulation of the wound environment
C. Activation of cell proliferation
Severe sepsis is differentiated from sepsis by A. history of premorbid conditions such as diabetes B. Positive blood cultures for bacteria or fungus C. Acute organ failure such as renal insufficiency D. Prolonged arterial hypotension
C. Acute organ failure such as renal insufficiency
When should cryoprecipitate be given to a patient needing a massive transfusion of packed RBCs? A. 1 unit of cryoprecipitate should be given for each unit of PRBCs B. 10 units of cryoprecipitate should be given for each unit of PRBCs C. After 6 units of PRBCs, cryoprecipitate should be given if the serum fibrinogen level is< 100 mg/di D. Never, fresh frozen plasma will provide the necessary factors
C. After 6 units of PRBCs, cryoprecipitate should be given if the serum fibrinogen level is< 100 mg/di
Which of the following will result in a subnormal SvO2? A. Fluid overload B. Increased PaO2 C. Anemia D. Hypothermia
C. Anemia
A patient with a prolonged aPTT and deep venous thrombosis should be evaluated for which of the following conditions? A. Heparin-induced thrombocytopenia B. Thrombotic thrombocytopenic purpura C. Antiphospholipid syndrome D. Protein C deficiency
C. Antiphospholipid syndrome
Which of the following can be used to indirectly estimate the oxygen debt incurred during shock? A. Arterial pH B. Arteriolar-alveolar 02 gradient C. Base deficit D. Serum bicarbonate
C. Base deficit
The most common indication for pediatric liver transplantation is A. Wilson's disease B. Alagille's syndrome C. Biliary atresia D. Tyrosinemia
C. Biliary atresia
The most common cause of hepatic abscess in the United States is A. GI infection with entoameoba histolytica 8. Pylephlebitis from appendicitis C. Biliary tract procedures D. Primary bacterial infection after septicemia
C. Biliary tract procedures
A 75-year-old woman presents to the ED following an MVA. She has decreased strength and sensation in her arms. She has normal strength and sensation in her legs. The most likely diagnosis is A. Brown-Sequard syndrome B. Anterior cord syndrome C. Central cord syndrome D. Posterior cord syndrome
C. Central cord syndrome
Which of the following would increase the effect of warfarin and require a decrease in the dose given for anticoagulation? A. Barbiturates B. Corticosteroids C. Cephalosporins D. Oral contraceptive pills
C. Cephalosporins
New onset of glucose intolerance in a TPN dependent patient can be due to A. Zinc deficiency B. Copper deficiency C. Chromium deficiency D. Manganese deficiency
C. Chromium deficiency
The most common etiology of liver failure in patients undergoing liver transplantation is A. Alcoholic cirrhosis B. Metabolic disease C. Chronic hepatitis D. Fulminant (acute) liver failure
C. Chronic hepatitis
Which of the following is considered the most effective therapy for venous stasis ulcers? A. Supplemental vitamin A B. Topical antibiotic ointment C. Compression therapy D. Hyperbaric therapy
C. Compression therapy
Management of suspected blunt cardiac injury includes which of the following? A. Mandatory admission to an intensive care unit B. Cardiac catheterization C. Continuous monitoring if EKG abnormalities are noted D. Cardiac enzymes
C. Continuous monitoring if EKG abnormalities are noted
Pneumoperitoneum results in which of the following? A. Decreased plasma rennin B. Decreased antidiuretic hormone (ADH) C. Decreased glomerular filtration rate D. Decreased free water absorption in the distal tubules
C. Decreased glomerular filtration rate
A patient with partial albinism and a bleeding disorder most likely has A. von Willebrand's disease B. Hemophilia C C. Dense granule deficiency D. Factor XIII deficiency
C. Dense granule deficiency
Preload is determined by A. End systolic volume B. End systolic pressure C. End diastolic volume D. End diastolic pressure
C. End diastolic volume
Which of the following are known effects of tumor necrosis factor (INF)? A. Decreases catabolic response B. Promotes insulin entry into cells C. Enhances the expression of eicosanoids D. Delays activation of the coagulation pathway
C. Enhances the expression of eicosanoids
Which of the following has been shown to decrease the rate of pancreatic abscess in patients with necrotizing pancreatitis? A. Prophylactic antibiotics B. Frequent imaging with percutaneous sampling of new fluid collections C. Enteral nutrition D. Parenteral nutrition
C. Enteral nutrition
Which of the following is associated with an increased incidence of liver cancer? A. Salted food B. Infection with Hepatitis A C. Exposure to aflatoxin D. Helicobacter pylori
C. Exposure to aflatoxin
Which nutrient is proportionally increased in "pulmonary failure" enteral formula? A. Carbohydrate B. Protein C. Fat D. Vitamins
C. Fat
Which of the following characteristics is typically seen in a high-reliability (low error) surgical service? A. Personal accountability is stressed in a public forum such as a morbidity and mortality conference on a regular (usually weekly) basis B. Hierarchical responsibility is imposed, with final authority resting with the attending surgeon C. Friendly open relationships exist between all members of the surgical team including nurses and clerical staff D. The culture of the work environment stresses following established protocols.
C. Friendly open relationships exist between all members of the surgical team including nurses and clerical staff
What is the most abundant amino acid in the human body? A. Leucine B. Tyrosine C. Glutamine D. Alanine
C. Glutamine
After CT scan, she is shown to have a liver laceration as shown below. There is a 4-cm laceration into the right lobe with a 10-cm subcapsular hematoma (see Fig. 7-11). What grade liver injury does she have? A. Grade l B. Grade II C. Grade III D. Grade IV
C. Grade III
Trastuzumab is a monoclonal antibody which targets which of the following cell receptors in susceptible patients with breast cancer? A. BRAC-1 B. BRAC-2 C. HER2 D. CAD-1
C. HER2
Which of the following is a proto-oncogene that is activated to promote malignant growth by gene amplification? A. BRCA l B. ras C. HER2/neu D. p53
C. HER2/neu
Which of the following devices is most advantageous for hemostasis during a thyroidectomy? A. Monopolar electrocautery B. Bipolar electrocautery C. Harmonic scalpel D. Argon coagulator
C. Harmonic scalpel
The most common vascular complication after liver transplantation is A. Hepatic vein thrombosis B. Portal vein thrombosis C. Hepatic artery thrombosis D. Inferior vena cava thrombosis
C. Hepatic artery thrombosis
Which of the following is an indication for CT of the chest to rule out a thoracic aortic injury? A. Left hemopneumothorax B. Respiratory distress ·with multiple rib fractures C. High speed head-on MVC with normal chest radiograph D. Left scapular pain
C. High speed head-on MVC with normal chest radiograph
First line therapy in an adult with idiopathic thrombocytopenia purpura includes A. Retuximab B. Splenectorny C. IV immunoglobulin D. Desmopressin
C. IV immunoglobulin
A "field effect" is best described as A. The effect of oncogene amplification in a cell on the adjacent cells B. The effect of loss of tumor-suppressor gene function in a cell on the adjacent cells C. Increased oncogene amplification or loss of tumor-suppressor gene function in a group of cells D. The effect of radiation on a tumor
C. Increased oncogene amplification or loss of tumor-suppressor gene function in a group of cells
A 40-year-old man is struck in the head. A CT scan is obtained, which is shown below. What is the diagnosis? A. Subdural hematoma B. Subarachnoid hemorrhage C. Intraparenchymal hemorrhage D. Epidural hematoma
C. Intraparenchymal hemorrhage
Which of the following is INCORRECT? A. A feature of malignant cells is invasion B. In situ cancer lies above the basement membrane C. Invasion involves changes in adhesion, motility, and proteolysis of extracellular matrix D. E-cadherin molecules increase invasion
C. Invasion involves changes in adhesion, motility, and proteolysis of extracellular matrix
The incidence of breast cancer is highest in developed nations with the exception of A. France B. England C. Japan D. Australia
C. Japan
The most appropriate treatment of a lymphocele following renal transplantation is A. Observation until resolution B. Percutaneous aspiration C. Laparoscopic or open peritoneal window D. Open exploration with sclerotherapy
C. Laparoscopic or open peritoneal window
A 20-year-old young man presents with a left anterior 8th intercostal space stab wound. He is in no distress and a chest x-ray is normal. A diagnostic peritoneal lavage is performed and has a RBC count of 8,000/μl and a WBC count of 300/μl. Which of the following is the best treatment for this patient? A. Observation only B. CT scan C. Laparoscopy D. Exploratory Laparotomy
C. Laparoscopy
What is the most common cancer in the world? A. Breast B. Gastric C. Lung D. Liver
C. Lung
Anti-diuretic hormone (ADH) is secreted in response to shock and remains elevated for approximately 1 week. Which of the following is seen as a result of this increased level of ADH? A. Decreased water permeability in the distal tubule B. Increased sodium loss in the distal tubule C. Mesenteric vasoconstriction D. Mesenteric vasodilation
C. Mesenteric vasoconstriction
The topical antimicrobial agent mafenide acetate is most likely to cause which of the following complications: A. Methemoglobinemia B. Neutropenia C. Metabolic acidosis D. Nephrotoxicity
C. Metabolic acidosis
Which of the following is the most common etiology of Li-Fraumeni syndrome? A. Exposure to aflatoxin B. Exposure to radiation C. Mutation in the p53 gene D. Mutation in the BRCA1 gene
C. Mutation in the p53 gene
A 62-year-old man is involved in a moving vehicle accident. He suffered significant blunt trauma to the sternum during the accident. He has a systolic blood pressure of 95 on arrival to the ER. His CVP is 15 and his CXR is normal. Which of the following is the most likely cause of his hypotension? A. Cardiac contusion B. Spinal cord injury C. Myocardial infarction D. Intra-abdominal hemorrhage
C. Myocardial infarction
Which of the following statements concerning N20 pneumoperitoneum is true A. N2O is flammable, therefore, electrosurgery should not be used B. Minute ventilation is increased in patients with N20 pneumoperitoneum when compared to CO2 C. N2O pneumoperitoneum is more analgesic than CO2 pneumoperitoneum D. N20 is the gas of choice to use for oncologic procedures
C. N2O pneumoperitoneum is more analgesic than CO2 pneumoperitoneum
The first cells to migrate into a wound are A. Macrophages B. T lymphocytes C. PMNs D. Fibroblasts
C. PMNs
A patient develops a high output fistula following abdominal surgery. The fluid is sent for evaluation with the results: Na 135 K S Cl 70. Which of the following is the most likely source of the fistula? A. Stomach B. Small bowel C. Pancreas D. Biliary tract
C. Pancreas
Which of the following is an early ECG change seen in hyperkalemia? A. Prolonged PR interval B. Sine wave formation C. Peaked T waves D. Flattened P wave
C. Peaked T waves
A patient presents with stable vital signs and respiratory distress after a stab wound to the chest. Chest tubes are placed and an air leak is noted. The patient is electively intubated. The patient arrests after positive pressure ventilation is started. What is the most likely diagnosis? A. Unrecognized hemorrhage in the abdomen B. Tension pneumothorax C. Pericardial tamponade D. Air embolism
C. Pericardial tamponade
Which of the following topical agents has been shown to improve healing in diabetic foot ulcers? A. Epithelial growth factor B. TGFß C. Platelet derived growth factor BB D. Endothelial growth factor
C. Platelet derived growth factor BB
Lawsuits and sentinel events most often are the result of A. Inadequate medical knowledge B. Substandard patient care C. Poor interpersonal and communication skills D. Unprofessional behaviour
C. Poor interpersonal and communication skills
Which of the following is the cation present in largest amounts in intracellular fluid? A. Sodium B. Chloride C. Potassium D. Calcium
C. Potassium
Learning by presenting errors at a morbidity and mortality conference is a part of which of the following ACGME core competencies? A. Patient care B. Medical knowledge C. Practice-based learning and improvement D. System-based practice
C. Practice-based learning and improvement
Which of the following is an indication for emergency department thoracotomy (EDT)? A. Witnessed cardiac arrest after a stab wound to the chest with 25 min of CPR B. Witnessed cardiac arrest after blunt trauma to the chest with 10 min of CPR C. Profound hypotension (systolic BP <70) following a stab wound to the chest D. Cardiac arrest in the ED following closed head injury
C. Profound hypotension (systolic BP <70) following a stab wound to the chest
Which of the following is a component of the University of Wisconsin preservation solution? A. Glucose B. Magnesium C. Raffinose D. Albumin
C. Raffinose
Which of the following is a cause of acute hypophosphatemia? A. Chronic ingestion of magnesium containing laxatives B. Insulin coma C. Refeeding syndrome D. Rhabdomyolosis
C. Refeeding syndrome
Which of the following is NOT one of the components of the PIRO staging system for sepsis? A. Pre-existing medical conditions B. Nature and extent of the infection C. Remedy (type of antibiotics given previously) D. Organ dysfunction
C. Remedy (type of antibiotics given previously)
When compared to open procedures, laparoscopic procedures A. Result in greater immune suppression B. Result in greater stress hormone production C. Result in higher serum cortisol levels D. Result in slower normalization of cytokine levels
C. Result in higher serum cortisol levels
Exposure to coal tar is associated with which of the following cancers? A. Bladder cancer B. Nasopharyngeal cancer C. Scrotal cancer D. Breast cancer
C. Scrotal cancer
Which layer of the intestine has the greatest tensile strength (i.e. ability to hold sutures)? A. Serosa B. Muscularis C. Submucosa D. Mucosa
C. Submucosa
Which of the following cytokines is released immediately after major injury? A. IL-10 B. IL-2 C. TNF-alpha D. TNF-beta
C. TNF-alpha
Which of the following immunosuppressive drugs inhibits IL-2 synthesis? A. Azathioprine B. Mycophenolate mofetil C. Tacrolimus D. Sirolimus
C. Tacrolimus
In direct measurement of blood pressure, what effect will overdamping have on the mean arterial pressure (MAP)? A. The MAP will be artificially high B. The MAP will be artificially low C. There is no effect on the MAP reading D. The MAP cannot be calculated if the system is overdamped
C. There is no effect on the MAP reading
Following biopsy which shows no vascular or lymphatic invasion, which of the following patients with hepatocellular carcinoma would be considered a candidate for liver transplantation? A. A single tumor in the left lobe 5.5 cm in diameter B. Two tumors, both in the right lobe, 3.5 cm and 2.5 cm in diameter C. Three tumors, in the right and left lobes, 2.5 cm, 2.8 cm, and 1.0 cm in diameter D. None of the above
C. Three tumors, in the right and left lobes, 2.5 cm, 2.8 cm, and 1.0 cm in diameter
A patient unresponsive to catecholamines after an acute myocardial infarction is placed on amrinone. Which of the following is a common side effect of amrinone? A. Neutropenia B. Anemia C. Thrombocytopenia D. Bone marrow failure
C. Thrombocytopenia
Which of the following is an eicosanoid? A. Tumour necrosis factor (INF) B. Arachidonic acid C. Thromboxane D. IL-10
C. Thromboxane
Which of the following molecularly targeted therapies directed against the HER2 gene? A. Cetuximab B. Sunitinib C. Trastuzumab D. Temsirolimus
C. Trastuzumab
Which of the following chemical carcinogens has been associated with angiosarcoma of the liver? A. Benzene B. Diethylstilbesterol C. Vinyl chloride D. Coal tar
C. Vinyl chloride
Ischemic changes to the skin can lead to decubitus ulcers. This ischemia occurs after what period of time in the same position? A. 10 minutes B. 30 minutes C. 1 hour D. 2 hours
D. 2 hours
A previously healthy 18-year-old woman is involved in a housefire and is admitted with 60% deep partial thickness burns to the ICU. A reasonable daily dose of vitamin A for this patient would be A. 1000mg B. 2500mg C. 10,000 mg D. 25,000 mg
D. 25,000 mg
The risk of small bowel obstruction in the first 10 years after left colectomy is A. <5% B. 10% C. 20% D. 30%
D. 30%
The risk of developing breast cancer by age 70 for a woman with a BRCA1 mutation is approximately A. 10% B. 20% C. 30% D. 40%
D. 40%
What is the maximum number of units of blood that can be autologously donated for elective surgery as long as the patient's hemoglobin is > 11 gm? A. A single donation can be made 2-3 weeks before surgery B. 2 donations can be made 2 and 4 weeks before surgery C. 3 donations can be made, 1 week apart, starting 4 weeks before surgery D. 5 donations can be made, 3-4 days apart, starting 6 weeks before surgery
D. 5 donations can be made, 3-4 days apart, starting 6 weeks before surgery
If 1 liter of 0.9% NaCl solution is given intravenously, how much will be distributed to the interstitial space? A. 100 cc B. 250 cc C. 400 cc D. 750 cc
D. 750 cc
APC (adenomatosis polyposis coli tumor-suppressor gene) is abnormal in what percentage of sporadic (non-syndromic) colon cancer? A. 5% B. 15% C. 50% D. 80%
D. 80%
A homeless, malnourished 48-year-old patient is admitted to the ICU after a severe blunt injury. A reasonable daily dose of vitamin C for this patient would be A. 60 mg B. 150 mg C. 400 mg D. >/= 1 g
D. >/= 1 g
Which of the following bladder pressures is an absolute indication for a decompressive laparotomy? A. >5 mmHg B. >15 mmHg C. >25 mmHg D. >35 mmHg
D. >35 mmHg
Which of the following trauma patients with airway compromise and failed endotracheal intubation should undergo emergency tracheostomy (rather than a cricothyroidotomy)? A. An 84-year-old male with blunt trauma to the neck B. A 65-year-old female with a stab wound to the submandibular region C. A 16-year-old male with a gunshot wound to the neck D. A 6-year-old female with a crush injury to the face
D. A 6-year-old female with a crush injury to the face
Which of the following tumor marker-disease associations is NOT correct? A. PSA and prostate cancer B. CEA and colon cancer C. CA19-9 and pancreatic cancer D. AFP and breast cancer
D. AFP and breast cancer
A patient with a right popliteal occlusion is scheduled for bypass. The initial incision is made on the left leg. The error is recognized, and no further dissection is carried out. The bypass is performed uneventfully on the right (correct) leg. This situation is A. An adverse event B. Negligence C. A sentinel event D. All of the above
D. All of the above
Cells sense changes in their environment which then subsequently affects gene expression in the cell. These changes are transmitted to the cell by "ligands;' substances that interact with receptors on or in the cell. Ligands are A. Peptides B. Dissolved gases C. Retinoids D. All of the above
D. All of the above
Functional genomics is a term used to describe which of following? A. Transcription of DNA B. Translation of RNA C. Proteomics D. All of the above
D. All of the above
HER2, also known as neu, is an oncogene that promotes malignant potential by A. Forming a hetrodimer with other EGFR members B. Increasing cell proliferation and growth C. Suppressing apoptosis D. All of the above
D. All of the above
Which of the follovvi.ng is a common initiating event for disseminated intravascular coagulation (DIC)? A. Spider bite B. Depressed skull fracture C. Type A influenza D. Amniotic fluid embolization
D. Amniotic fluid embolization
Which of the following should be performed in a patient with a suspected Marjolin ulcer? A. Hyperbaric therapy for 6 weeks B. Zinc supplementation C. Oral tetracycline for 6 weeks D. Biopsy
D. Biopsy
4 days following placement of a tracheostomy tube in the ICU, a significant amount of blood is suctioned from the tracheostomy. The most appropriate next step is A. Nothing B. Gentle repeat suctioning until clear C. Bedside bronchoscopy D. Bronchoscopy in the operating room
D. Bronchoscopy in the operating room
The initiating event in shock is A. Hypotension B. Decreased cardiac output C. Decreased oxygen delivery D. Cellular energy deficit
D. Cellular energy deficit
STI 157, also known as Gleevec, is a molecularly targeted therapy for A. Acute lymphocytic leukemia B. Acute myeloid leukemia C. Chronic lymphocytic leukemia D. Chronic myeloid leukemia
D. Chronic myeloid leukemia
Which of the following is an indication for operative intervention in a patient with an isolated duodenal hematoma? A. Hematoma >3 cm in diameter B. Total or near total occlusion of the duodenum by the hematoma C. Failure to resolve 10 days after admission D. Contained retroperitoneal leak
D. Contained retroperitoneal leak
Which of the following is the most likely diagnosis in a patient with a serum sodium of 152 mEq/L, a urine sodium concentration of >20 mEq/L, and a urine osmolality of >300 mOsm/L? A. Syndrome of inappropriate anti-diuretic hormone (SIADH) B. Diabetes insipidus C. Renal tubular disease D. Cushing's syndrome
D. Cushing's syndrome
Toll-like receptors play a role in the "danger signalling' pathway which modulates the immune response to injury. Stimulation of these receptors is by molecules released from A. The pituitary B. The adrenal medulla C. Macrophages D. Damaged cells
D. Damaged cells
Which of the following is the best choice to prepare a patient with type 1 von Willebrand's disease for surgery? A. Recombinant (pure) factor XIII B. von Willebrand factor C. Factor XIII D. Desmopressin
D. Desmopressin
The major improvement in burn survival in the 20th century can be attributed to the introduction of which of the following therapies: A. Antibiotics B. Central venous fluid resuscitation C. Nutritional support D. Early excision of the burn wound
D. Early excision of the burn wound
PTLD (posttransplant lymphoproliferative disorder) is caused by A. Poorly controlled immunosuppression B. Induction of lymphocyte antigens by immunosuppression C. Cytomegalovirus infection D. Epstein-Barr virus infection
D. Epstein-Barr virus infection
Hemophilia C is caused by a deficiency of A. Factor VIII B. Factor IX C. Factor X D. Factor XI
D. Factor XI
Which of the following is a life-threatening compromise to circulation and must be identified during the primary survey? A. Unstable pelvic fracture B. Pericardia! effusion C. 40% pneumothorax D. Femoral artery injury
D. Femoral artery injury
The antibiotic of choice in a penicillin allergic patient undergoing a cholecystectomy for acute cholecystitis is A. Ertepenem B. Ceftriaxone C. Vancomycin + Metronidazole D. Fluoroquinolone + Metronidazole
D. Fluoroquinolone + Metronidazole
Which of the following is found in patients with adrenal insufficiency? A. Hyperglycemia B. Hyperkalemia C. Hypercalcemia D. Hypernatremia
D. Hypernatremia
Hypomagnesemia clinically resembles which of the following? A. Hypoglycemia B. Hypokalemia C. Hypophosphatemia D. Hypocalcemia
D. Hypocalcemia
Which of the following is an anti-inflammatory cytokine? A. IL-1 B. IL-6 C. IL-8 D. IL-10
D. IL-10
At the conclusion of an operation for a colostomy closure, the patient is noted to have a H R of 130, temp of 102, and elevated expired PCO2. The most appropriate treatment is A. Irrigation of the abdominal cavity to remove cytokines and lower temperature B. Careful exploration to rule out a missed bowel injury C. Tylenol per rectum at the end of the procedure and careful observation D. Ice packs and intravenous dantrolene
D. Ice packs and intravenous dantrolene
The primary physiologic effect of nitric oxide (NO) is A. Increased platelet adhesion B. Increased leukocyte-endothelial adhesion C. Increased microthrombosis D. Increased smooth muscle relaxation
D. Increased smooth muscle relaxation
Which of the following is NOT a risk factor for developing a surgical site infection (SSI)? A. Radiation exposure B. Recent surgery C. Prolonged hospitalization D. Infancy
D. Infancy
Cyclosporine inhibits T-cell activation by A. Directly binding to T-cell surface membrane B. Increasing production ofIL-2 C. Decreasing production ofIL-10 D. Inhibiting calcineurin
D. Inhibiting calcineurin
Which of the following is the largest fluid compartment in body? A. Plasma B. Central spinal fluid C. Interstitial fluid D. Intracellular fluid
D. Intracellular fluid
A 4-year-old is brought hypotensive to the ED after an MVA. Peripheral IV is attempted but is unsuccessful. The next best access is A. Cordis introducer in the internal jugular vein B. Single lumen subclavian venous catheter C. Double lumen femoral venous catheter D. Intraosseous catheter
D. Intraosseous catheter
Which of the following is the primary fuel source in prolonged starvation? A. Fat B. Muscle (protein) C. Glycogen D. Ketone bodies
D. Ketone bodies
Which of the following is the best choice to replace isotonic (serum) fluid loss? A. D5 ¼ NS with 20 mEq KCJ/liter B. D5 ½ NS with 20 mEq KCl/liter C. 3% saline solution D. Lactated Ringer's
D. Lactated Ringer's
If air embolism is suspected during placement of a central line, the patient should be placed in which of the following positions? A. Supine B. Prone C. Right lateral decubitus D. Left lateral decubitus
D. Left lateral decubitus
Bowel removed from a living donor for small bowel transplant is most commonly A. Proximal jejunum B. Mid to distal jejunum C. Proximal ileum D. Mid to distal ileum
D. Mid to distal ileum
Which of the following increases the risk of wrong-site surgery? A. Surgery late in the day B. Thin patient (BMI <22) C. Surgeon running multiple rooms D. Multiple surgeons involved in the same operation
D. Multiple surgeons involved in the same operation
Which of the following should be used to prepare a with mild renal insufficiency (BUN 38, Creatinine 1.5) for angiography? A. Nothing B. Oral hydration (3 liters) during the 24 hours before the procedure C. Intravenous hydration for 12 hours after the procedure D. N-acetylcysteine
D. N-acetylcysteine
Which of the following is most likely to cause a diabetic ulcer? A. Uncontrolled hyperglycemia B. Large vessel ischemia (peripheral vascular disease) C. Small vessel ischemia D. Neuropathy
D. Neuropathy
A patient with breast cancer is considered to be cancer free (no further risk of primary recurrence or metastatic tumor) after A. 3 years B. 5 years C. 10 years D. Never
D. Never
The tensile strength of a completely healed wound approaches the strength of uninjured tissue A. 2 weeks after injury B. 3 months after injury C. 12 months after injury D. Never
D. Never
A patient with epidermolysis bullosa (EB) requires placement of a feeding gastrostomy due to esophageal erosions. What kind of dressing should be placed after surgery? A. None- leave the wound open to air B. Steri-strips, gauze, and atraumatic tape C. Tissue adhesive only D. Nonadhesive pad with circumferential bulky dressing
D. Nonadhesive pad with circumferential bulky dressing
A patient undergoing laparoscopic colon resection is noted to have a decreased urine output during the last hour of the case. A bolus is given at the end of the case. One hour later, there is still very poor urine output. The appropriate treatment is A. Repeat the bolus B. IV furosemide C. Check urine electrolytes D. None of the above
D. None of the above
In critically ill postoperative patients, monitoring with a pulmonary artery catheter A. Decreases mortality B. Decreases the rate of postoperative myocardial infarction C. Decreases ICU length of stay D. None of the above
D. None of the above
Which of the following can contribute to hyperkalemia in patients with renal insufficiency? A. Loop diuretics B. Aspirin C. Calcium channel blockers D. Nonsteroidal anti-inflammatory drugs (NSAIDs)
D. Nonsteroidal anti-inflammatory drugs (NSAIDs)
For average-risk patients, routine cancer screening is recommended for all but the following disease? A. Breast cancer B. Colorectal cancer C. Cervical cancer D. Pancreatic cancer
D. Pancreatic cancer
Which of the following is most likely to accurately estimate cardiac output? A. Sternal notch ultrasonography B. Transesophageal ultrasonography C. lmpedence cardiography D. Partial carbon dioxide rebreathing
D. Partial carbon dioxide rebreathing
Back table preparation of a donor pancreas prior to transplantation includes A. Removal of the donor duodenum B. Removal of the tail of the pancreas with the spleen C. Ligation of the proximal splenic vein D. Placement of an arterial graft to connect the splenic and superior mesenteric arteries
D. Placement of an arterial graft to connect the splenic and superior mesenteric arteries
The most effective treatment for bleeding secondary to thrombotic thrombocytopenic purpura is A. Platelet transfusion B. Desmopressin C. Emergency splenectomy D. Plasmapheresis
D. Plasmapheresis
Bleeding in patients with the Bernard-Soulier syndrome is treated with A. Factor V B. Factor VII C. Fresh frozen plasma transfusion D. Platelet transfusion
D. Platelet transfusion
Bleeding in patients with thrombasthenia is treated with A. Factor V B. Factor VII C. Fresh frozen plasma transfusion D. Platelet transfusion
D. Platelet transfusion
Mutations in the Rb 1 gene were first associated with A. Breast cancer B. Colorectal cancer C. Rhabdomyosarcoma D. Retinoblastoma
D. Retinoblastoma
In measuring cardiac output with a Swan-Ganz catheter, a rapid bolus of saline is used. What is the best temperature for that bolus? A. 4° centigrade B. 15° centigrade C. 30° centigrade D. Room temperature
D. Room temperature
The most common arrhythmia seen with CO2 pneumoperitoneum is A. Ventricular tachycardia B. Superventricular tachycardia C. Sinus tachycardia D. Sinus bradycardia
D. Sinus bradycardia
The culture of an organization is an important component of safety. Which of the following characteristics of the traditional surgical culture helps improve safety in the operating room? A. Hierarchical structure with the surgeon responsible for the final outcome B. Personal accountability at the weekly morbidity and mortality conference C. Ability to work equally well under non stressful and stressful conditions D. The ability to solve a problem once the problem is clearly identified.
D. The ability to solve a problem once the problem is clearly identified.
Which of the following best assesses clot strength? A. Clinical history B. Thrombin levels C. Ivy bleeding time D. Thromboelastogram (TEG)
D. Thromboelastogram (TEG)
A serious medical error is committed by the chief resident. The best way to teach him or her and his or her fellow residents about this situation is A. To make the resident personally accountable in a public forum such as morbidity and mortality conference B. To make the resident personally accountable in a one-on-one discussion with his or her attending C. To have the resident meet with risk management to understand the potential medicolegal implications of the error D. To use the error to analyse the system that allowed it to happen, and make suggestions for prevention of the error in the future
D. To use the error to analyse the system that allowed it to happen, and make suggestions for prevention of the error in the future
Which of the following does NOT require an electrical current to coagulate tissue? A. Monopolar cautery B. Bipolar cautery C. Mixed current cautery D. Ultrasonic shears device
D. Ultrasonic shears device
Which of the following is the best initial treatment for acute traumatic pericardial tamponade in a patient with a systolic blood pressure of 90 mmHg? A. Immediate ER thoracotomy with pericardiotomy and repair of the injury B. ER thoracoscopy for pericardial drainage C. Fluid resuscitation to stabilize blood pressure during transfer to the operating room for definitive repair D. Ultrasound guided placement of a pericardial catheter
D. Ultrasound guided placement of a pericardial catheter
Which of the following is a risk factor for a retained surgical sponge? A. Surgery which takes longer than 6 hours B. Use of >30 sponges C. Pelvic surgery D. Unplanned change in procedure
D. Unplanned change in procedure
Addition of which of the following leads to continuous EKG monitoring will improve the ability to detect myocardial ischemia? A. Left arm B. Right arm C. V1 D. V4
D. V4
Shock following severe carbon monoxide poisoning is most commonly A. Hypovolemic shock B. Neurogenic shock C. Cardiogenic shock D. Vasodilatory shock
D. Vasodilatory shock
Which vitamin is not present in commercially prepared intravenous vitamin preparations and, therefore, must be supplemented in a patient receiving TPN? A. Vitamin A B. Vitamin D c. Vitamin E D. Vitamin K
D. Vitamin K
The typical CXR finding in anthrax is A. Bilateral fluffy infiltrates B. Pneumothorax C. Cavitating lesions, primarily in the upper lobes D. Widened mediastinum and pleural effusions
D. Widened mediastinum and pleural effusions
